Diagnostic Testing and Specimen 2
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What is the recommended technique for collecting a wound culture specimen?

  • Collect from the outer edges of the wound using a non-sterile swab.
  • Collect from the surface of the skin surrounding the wound.
  • Collect from the inside of the wound, the cleanest area, using a sterile swab. (correct)
  • Collect from a previously cleaned area, without using any swab.

    • When should pain medication be administered prior to a wound culture collection?

  • Approximately 30 minutes before the procedure if it is expected to be painful. (correct)
  • Not at all, unless the patient requests it.
  • During the procedure to minimize patient discomfort.
  • Immediately after the collection is completed.

    • What practice is recommended for conducting a capillary blood glucose (CBG) test on infants?

  • Use the heel for blood collection. (correct)
  • Collect blood directly from the fingerpad.
  • Perform the prick on the index finger for optimal results.
  • Avoid using gloves during the procedure.

    • Which step is essential before using a glucometer for blood glucose testing?

    <p>Load the strip and select the appropriate settings.</p> Signup and view all the answers

    How should used lancets and glucometer strips be disposed of after CBG testing?

    <p>Place in the designated sharps container.</p> Signup and view all the answers

    What is the normal range for a white blood cell count?

    <p>5,000 - 10,000</p> Signup and view all the answers

    How is PTT used in medical monitoring?

    <p>To monitor Heparin therapy</p> Signup and view all the answers

    What is the normal fasting glucose range?

    <p>60 - 110 mg/dL</p> Signup and view all the answers

    What does an elevated Hemoglobin A1C indicate?

    <p>An increase in average blood glucose levels over the past 3 months</p> Signup and view all the answers

    What is the critical value for triglycerides?

    <blockquote> <p>400 mg/dL</p> </blockquote> Signup and view all the answers

    Which test measures kidney function, indicating possible kidney failure?

    <p>Creatinine</p> Signup and view all the answers

    What should a patient do before a cholesterol test?

    <p>Fast for 12 - 14 hours</p> Signup and view all the answers

    What is the normal range for electrolyte potassium levels?

    <p>3.5 - 5 mEq/L</p> Signup and view all the answers

    Which type of urine specimen is best for a urine culture?

    <p>Midstream specimen</p> Signup and view all the answers

    What treatment should be given for hypoglycemia?

    <p>Orange juice or fruit juice</p> Signup and view all the answers

    What factor can lower HDL cholesterol levels?

    <p>Smoking</p> Signup and view all the answers

    What is the purpose of collecting a sputum specimen?

    <p>To analyze respiratory secretions for infection</p> Signup and view all the answers

    What is the normal urine pH range?

    <p>4.6 - 8</p> Signup and view all the answers

    What should be done if the PTT value is below the therapeutic range?

    <p>Increase heparin dosage.</p> Signup and view all the answers

    Which condition is indicated by a high INR value?

    <p>Over-dosage of Coumadin</p> Signup and view all the answers

    Which of the following statements regarding a complete blood count (CBC) is true?

    <p>Normal red blood cell count for females is 4.2 to 5.4 million.</p> Signup and view all the answers

    What is the purpose of performing a glucose tolerance test on a pregnant individual?

    <p>To assess carbohydrate metabolism.</p> Signup and view all the answers

    Which test provides information about a patient's average blood sugar levels over the past three months?

    <p>Hemoglobin A1c test</p> Signup and view all the answers

    What condition is reflected by a normal fasting glucose reading of 70 mg/dL?

    <p>Normal carbohydrate metabolism</p> Signup and view all the answers

    In a white blood cell differential count, which type of cell is NOT normally included?

    <p>Platelets</p> Signup and view all the answers

    What must a patient do prior to undergoing a fasting glucose test?

    <p>Be nothing by mouth after midnight.</p> Signup and view all the answers

    How can low PT levels affect Coumadin therapy?

    <p>Require an increase in Coumadin dosage.</p> Signup and view all the answers

    What is the normal range for platelet (thrombocyte) counts?

    <p>150,000 to 400,000</p> Signup and view all the answers

    What should be avoided to prevent interference with laboratory test results?

    <p>Red meat and cantaloupe</p> Signup and view all the answers

    What precaution is essential when collecting wound cultures?

    <p>Use a sterile swab post-cleaning</p> Signup and view all the answers

    Where should a blood sample for a capillary blood glucose (CBG) test be collected on an infant?

    <p>From the heel</p> Signup and view all the answers

    What type of medication should be documented prior to specimen collection?

    <p>Anticoagulants</p> Signup and view all the answers

    Which of the following actions is appropriate for reducing contamination during specimen collection?

    <p>Collecting from the outer edge of the area</p> Signup and view all the answers

    What is the recommended site for pricking a finger during a CBG test to avoid discomfort?

    <p>Side of the finger</p> Signup and view all the answers

    When should pain medication ideally be administered related to specimen collection?

    <p>30 minutes prior to the procedure</p> Signup and view all the answers

    How should a blood sample for a CBG test be collected effectively?

    <p>By using a lancet to prick the side of the finger</p> Signup and view all the answers

    During a dressing change, what is a crucial step for obtaining accurate wound culture specimens?

    <p>Collecting from inside the wound</p> Signup and view all the answers

    Which of the following practices is NOT recommended when collecting a urine specimen?

    <p>Collect only after the first urination of the day</p> Signup and view all the answers

    What indicates very poor diabetic control in terms of blood sugar levels?

    <p>10 to 20</p> Signup and view all the answers

    What is the normal range for uric acid levels in milligrams per deciliter?

    <p>3 to 7</p> Signup and view all the answers

    Which of the following is a critical value for triglycerides that requires immediate notification to a provider?

    <p>Greater than 400 mg/dL</p> Signup and view all the answers

    Which scenario typically indicates dehydration rather than kidney impairment when assessing BUN and creatinine levels?

    <p>BUN elevated and creatinine normal</p> Signup and view all the answers

    What is the normal range for HDL cholesterol levels in milligrams per deciliter?

    <p>30 to 80</p> Signup and view all the answers

    What type of urine collection requires the patient to collect urine for a full 24-hour period?

    <p>24-hour urine urinalysis</p> Signup and view all the answers

    If a patient is hypoglycemic and unable to swallow, what is the appropriate treatment?

    <p>Intravenous glucose solution</p> Signup and view all the answers

    What is the importance of the specific gravity range in urinalysis?

    <p>To assess hydration status</p> Signup and view all the answers

    What is the correct normal range for creatinine in milligrams per deciliter?

    <p>0.6 to 1.2</p> Signup and view all the answers

    What factors should a patient avoid for at least 12 to 14 hours before a cholesterol test?

    <p>Smoking and alcohol</p> Signup and view all the answers

    Study Notes

    Complete Blood Count

    • No special preparation
    • Normal white blood cell count: 5,000 - 10,000
    • White blood cell count with differential includes neutrophils, basophils, monocytes, eosinophils, and lymphocytes
    • Normal red blood cell count: 4.2 - 6.1 million for males, 4.2 - 5.4 million for females
    • Normal hematocrit: 42 - 52% for males, 37 - 47% for females
    • Normal hemoglobin: 14 - 18 g/dL for males, 12 - 16 g/dL for females
    • Normal platelet count: 150,000 - 400,000/mm3

    Coagulation Tests

    • PTT: 1.5 - 2.5 times the control

    • Used to monitor Heparin therapy

    • If PTT is too low: increase Heparin dose

    • If PTT is too high: decrease Heparin dose

    • PT: 1.5 - 2 times the control

    • Used to monitor Coumadin (Warfarin) therapy

    • If PT is too low: increase Coumadin dose

    • If PT is too high: decrease Coumadin dose

    • INR: 2 - 3

    • Used in conjunction with PT for clients on Coumadin

    • If INR is below 2: Increase Coumadin dose

    • If INR is above 3: Decrease Coumadin dose

    Glucose Test

    • Normal fasting glucose: 60 - 110 mg/dL
    • Fasting Glucose Test: NPO after midnight, blood drawn first thing in the morning
    • Acute Che or Capillary Glucose: Finger stick, used for frequent monitoring
    • Postprandial Glucose: 2 hours after a meal

    Hemoglobin A1C

    • Also known as glycosylated hemoglobin
    • Reflects average blood glucose levels over 120 days (3 months)
    • No special preparation, can be drawn at any time
    • Normal value: 4 - 7%
    • Elevated in patients with diabetes
    • Lower values indicate better blood sugar control

    Hypoglycemia

    • Blood sugar below 60 mg/dL
    • Can be very dangerous
    • Symptoms: headache, dizziness, confusion, seizures
    • Treatment:
      • Give orange juice or other fruit juice
      • Give hard candy or honey
      • Administer glucagon (subcutaneous, intramuscular, or intravenous)
      • Administer 10% or 50% glucose intravenously

    Uric Acid

    • Elevated in patients with gout
    • No special preparation
    • Normal: 3 - 7 mg/dL

    Creatinine

    • Measures kidney function
    • Elevated in kidney failure
    • Normal: 0.6 - 1.2 mg/dL

    Blood Urea Nitrogen (BUN)

    • Measures kidney function
    • Elevated in dehydration and kidney impairment
    • Normal: 10 - 20 mg/dL

    Electrolytes

    • Potassium: 3.5 - 5 mEq/L
    • Sodium: 135 - 145 mEq/L

    Triglycerides

    • NPO for 12 - 14 hours prior to the test
    • No alcohol for 24 hours prior to the test
    • Normal: 40 - 160 mg/dL for males, 35 - 135 mg/dL for females
    • Critical value: > 400 mg/dL

    Lipoproteins

    • HDL (High Density Lipoprotein): 30 - 80 mg/dL
    • Considered "good" cholesterol
    • Higher levels are better
    • NPO for 12 - 14 hours prior to the test
    • Smoking and alcohol can lower HDL levels
    • LDL (Low Density Lipoprotein): 60 - 180 mg/dL
    • Considered "bad" cholesterol
    • Lower levels are better
    • VLDL (Very Low Density Lipoprotein): 25 - 50 mg/dL
    • Considered "very bad" cholesterol
    • Lower levels are better

    Cholesterol

    • Fasting for 12 - 14 hours prior to the test
    • Low fat diet prior to the test
    • No alcohol for 24 hours prior to the test
    • Normal: < 200 mg/dL

    Urinalysis

    • Midstream: Cleanest portion of the urine sample, collected in a sterile container
    • First Voided Specimen: First void in the morning, used for pregnancy tests and urine cultures
    • Sterile/Catheterized: Collected from a sterile catheter, used for cultures and other tests
    • Residual Urine: Assessed by having the patient void normally, then collecting a sample with a catheter 10 minutes later to check for urine remaining in the bladder
    • Normal Urine Findings:
      • Color: Pale yellow or amber, clear
      • pH: 4.6 - 8
      • Specific Gravity: 1.003 - 1.030
      • Glucose: Negative
      • Bilirubin: Negative
      • Ketones: Negative
      • Protein: Negative
      • Red Blood Cells: 0 - 2
      • White Blood Cells: 0 - 4
      • Bacteria: Negative

    Blood Culture

    • Usually drawn from two sides
    • Always draw blood culture before administering antibiotics
    • The blood culture will be done first, then the antibiotic will be administered

    Sputum Specimen

    • Best collected early in the morning before the patient has cleared their respiratory tract
    • Encourage fluids to liquify secretions
    • Do not contaminate the specimen container
    • Respiratory treatment may be required for thick secretions
    • Collect sputum from the lungs, not the mouth

    24-Hour Urine Collection

    • Collect all urine voided over a 24-hour period
    • Begin the collection after the initial urine output and record the time and date
    • Keep the specimen container on ice
    • If any urine is missed or contaminated, the collection must be restarted

    Stool Specimen

    • Also known as guaiac
    • Not sterile, collect clean specimen
    • Warm, fresh specimen preferred
    • If testing for ova and parasites, collect samples from different areas of the stool
    • If the patient is a baby, the entire diaper can be sent to the lab
    • Foods and medications that can affect the test: red meat, cantaloupe, uncooked broccoli, turnips, vitamin C, aspirin, and iron supplements
    • Note if the patient is on any anticoagulants

    Specimen Collection

    • Urine Contamination: Ensure patients understand the importance of not urinating during steel specimen collection to avoid contamination.
    • Digital Exam: May be necessary for certain specimen collections.
    • Wound Culture Collection: Collect after cleaning the wound to obtain the most accurate culture.
    • Wound Cleaning: Clean the wound to remove old drainage before collecting a wound culture.
    • Pain Medication: Administer pain medication approximately 30 minutes prior to the procedure if it is expected to be painful.
    • Wound Culture Location: Collect the specimen from the inside of the wound, the cleanest area, using a sterile swab.

    Capillary Blood Glucose (CBG) Testing

    • Gloves: Wear gloves during CBG testing.
    • Lancets: Utilize automatic lancet devices for safe and efficient finger pricking.
    • Glucometer Setup: Set up the glucometer by loading the strip and selecting the appropriate settings.
    • Finger Prick Location: Avoid sticking the middle of the finger; prick the sides or outer areas.
    • Infant CBG Collection: Conduct CBG testing on the heel for infants.
    • Blood Collection Technique: Use a downward motion with the lancet to encourage blood flow.
    • Glucometer Application: Place the blood drop on the appropriate area of the glucometer strip.
    • Documentation: Record the blood glucose reading after it displays on the glucometer.
    • Waste Disposal: Discard the strip and lancet in the designated sharps container and dispose of gloves properly.

    Complete Blood Count

    • No special preparation needed for the test.
    • Normal white blood cell count: 5,000 - 10,000 cells/mm3
    • White blood cell count with differential measures the different types of white blood cells including neutrophils, basophils, monocytes, eosinophils, and lymphocytes.
    • Normal red blood cell count: 4.2 - 6.1 million cells/mm3 for males, 4.2 - 5.4 million cells/mm3 for females.
    • Normal hematocrit: 42 - 52% for males, 37 - 47% for females.
    • Normal hemoglobin: 14 - 18 g/dL for males, 12 - 16 g/dL for females.
    • Normal platelet count: 150,000 - 400,000/mm3.

    Coagulation Tests

    • PTT measures how long it takes for blood to clot.

    • Normal PTT: 1.5 - 2.5 times the control.

    • Used to monitor Heparin therapy.

    • If PTT is too low: increase Heparin dose.

    • If PTT is too high: decrease Heparin dose.

    • PT is a test that assesses the extrinsic pathway of the coagulation cascade.

    • Normal PT: 1.5 - 2 times the control.

    • Used to monitor Coumadin (Warfarin) therapy.

    • If PT is too low: increase Coumadin dose.

    • If PT is too high: decrease Coumadin dose.

    • INR is a standardized measure of PT.

    • Normal INR: 2 - 3.

    • Used in conjunction with PT for clients on Coumadin.

    • If INR is below 2: Increase Coumadin dose.

    • If INR is above 3: Decrease Coumadin dose.

    Glucose Test

    • Normal fasting glucose: 60 - 110 mg/dL.
    • Fasting Glucose Test requires the patient to be NPO after midnight.
    • Acute Che or Capillary Glucose is performed with a finger stick for frequent monitoring.
    • Postprandial Glucose is drawn 2 hours after a meal.

    Hemoglobin A1C

    • Also known as glycosylated hemoglobin.
    • Reflects the average blood glucose levels over 120 days (3 months).
    • No special preparation needed, can be drawn at any time.
    • Normal value: 4 - 7%.
    • Elevated in patients with diabetes.
    • Lower values indicate better blood sugar control.

    Hypoglycemia

    • Blood sugar below 60 mg/dL.
    • Symptoms: headache, dizziness, confusion, seizures.
    • Treatment:
      • Give orange juice or other fruit juice.
      • Give hard candy or honey.
      • Administer glucagon (subcutaneous, intramuscular, or intravenous).
      • Administer 10% or 50% glucose intravenously.

    Uric Acid

    • Elevated in patients with gout.
    • No special preparation needed.
    • Normal: 3 - 7 mg/dL.

    Creatinine

    • Measures kidney function.
    • Elevated in kidney failure.
    • Normal: 0.6 - 1.2 mg/dL.

    Blood Urea Nitrogen (BUN)

    • Measures kidney function.
    • Elevated in dehydration and kidney impairment.
    • Normal: 10 - 20 mg/dL.

    Electrolytes

    • Potassium: 3.5 - 5 mEq/L.
    • Sodium: 135 - 145 mEq/L.

    Triglycerides

    • NPO for 12 - 14 hours prior to the test.
    • No alcohol for 24 hours prior to the test.
    • Normal: 40 - 160 mg/dL for males, 35 - 135 mg/dL for females.
    • Critical value: > 400 mg/dL.

    Lipoproteins

    • HDL (High Density Lipoprotein): 30 - 80 mg/dL.
    • Considered "good" cholesterol.
    • Higher levels are better.
    • NPO for 12 - 14 hours prior to the test.
    • Smoking and alcohol can lower HDL levels.
    • LDL (Low Density Lipoprotein): 60 - 180 mg/dL.
    • Considered "bad" cholesterol.
    • Lower levels are better.
    • VLDL (Very Low Density Lipoprotein): 25 - 50 mg/dL.
    • Considered "very bad" cholesterol.
    • Lower levels are better.

    Cholesterol

    • Fasting for 12 - 14 hours prior to the test.
    • Low fat diet prior to the test.
    • No alcohol for 24 hours prior to the test.
    • Normal: < 200 mg/dL.

    Urinalysis

    • Midstream: Cleanest portion of the urine sample, collected in a sterile container.
    • First Voided Specimen: First void in the morning, used for pregnancy tests and urine cultures.
    • Sterile/Catheterized: Collected from a sterile catheter, used for cultures and other tests.
    • Residual Urine: Assessed by having the patient void normally, then collecting a sample with a catheter 10 minutes later to check for urine remaining in the bladder.
    • Normal Urine Findings:
      • Color: Pale yellow or amber, clear.
      • pH: 4.6 - 8.
      • Specific Gravity: 1.003 - 1.030.
      • Glucose: Negative.
      • Bilirubin: Negative.
      • Ketones: Negative.
      • Protein: Negative.
      • Red Blood Cells: 0 - 2.
      • White Blood Cells: 0 - 4.
      • Bacteria: Negative.

    Blood Culture

    • Usually drawn from two sides.
    • Always draw blood culture before administering antibiotics.
    • The blood culture will be done first, then the antibiotic will be administered.

    Sputum Specimen

    • Best collected early in the morning before the patient has cleared their respiratory tract.
    • Encourage fluids to liquify secretions.
    • Do not contaminate the specimen container.
    • Respiratory treatment may be required for thick secretions.
    • Collect sputum from the lungs, not the mouth.

    24-Hour Urine Collection

    • Collect all urine voided over a 24-hour period.
    • Begin the collection after the initial urine output and record the time and date.
    • Keep the specimen container on ice.
    • If any urine is missed or contaminated, the collection must be restarted.

    Stool Specimen

    • Also known as guaiac.
    • Not sterile, collect clean specimen.
    • Warm, fresh specimen preferred.
    • If testing for ova and parasites, collect samples from different areas of the stool.
    • If the patient is a baby, the entire diaper can be sent to the lab.
    • Foods and medications that can affect the test: red meat, cantaloupe, uncooked broccoli, turnips, vitamin C, aspirin, and iron supplements.
    • Note if the patient is on any anticoagulants.

    Specimen Collection

    • Urine Contamination: Ensure patients understand the importance of not urinating during stool specimen collection to avoid contamination.
    • Digital Exam: May be necessary for certain specimen collections.
    • Wound Culture Collection: Collect after cleaning the wound to obtain the most accurate culture.
    • Wound Cleaning: Clean the wound to remove old drainage before collecting a wound culture.
    • Pain Medication: Administer pain medication approximately 30 minutes prior to the procedure if it is expected to be painful.
    • Wound Culture Location: Collect the specimen from the inside of the wound, the cleanest area, using a sterile swab.

    Capillary Blood Glucose (CBG) Testing

    • Gloves: Wear gloves during CBG testing.
    • Lancets: Utilize automatic lancet devices for safe and efficient finger pricking.
    • Glucometer Setup: Set up the glucometer by loading the strip and selecting the appropriate settings.
    • Finger Prick Location: Avoid sticking the middle of the finger; prick the sides or outer areas.
    • Infant CBG Collection: Conduct CBG testing on the heel for infants.
    • Blood Collection Technique: Use a downward motion with the lancet to encourage blood flow.
    • Glucometer Application: Place the blood drop on the appropriate area of the glucometer strip.
    • Documentation: Record the blood glucose reading after it displays on the glucometer.
    • Waste Disposal: Discard the strip and lancet in the designated sharps container and dispose of gloves properly.

    Complete Blood Count

    • A venipuncture test to assess blood components.
    • No special preparation needed.
    • White Blood Cell (WBC) Count
      • Normal range: 5,000 to 10,000 cells per microliter.
      • Differential: Counts individual white blood cell types (neutrophils, basophils, monocytes, eosinophils, lymphocytes).
    • Red Blood Cell (RBC) Count
      • Males: 4.2 to 6.1 million cells per microliter.
      • Females: 4.2 to 5.4 million cells per microliter.
    • Hematocrit (percentage of red blood cells in blood volume)
      • Males: 42 to 52%
      • Females: 37 to 47%
    • Hemoglobin (protein in RBCs that carries oxygen)
      • Males: 14 to 18 grams per deciliter.
      • Females: 12 to 16 grams per deciliter.
    • Platelet (Thrombocyte) (cells involved in blood clotting)
      • Normal range: 150,000 to 400,000 cells per microliter.

    Coagulation Tests

    • Assess blood clotting ability.
    • Partial Thromboplastin Time (PTT)
      • Monitors heparin therapy.
      • Therapeutic range: 1.5 to 2.5 times the control value.
      • Too low: Patient needs more heparin.
      • Too high: Patient is taking too much heparin.
    • Prothrombin Time (PT)
      • Monitors Coumadin (Warfarin) therapy.
      • Therapeutic range: 1.5 to 2 times the control value.
      • Too low: Patient needs more Coumadin.
      • Too high: Patient is taking too much Coumadin.
    • International Normalized Ratio (INR)
      • Used with PT for Coumadin monitoring.
      • Therapeutic range: 2 to 3.
      • Below 2: Patient needs more Coumadin.
      • Above 3: Patient is taking too much Coumadin.

    Glucose

    • Measures blood sugar levels.
    • Fasting Glucose Test
      • Normal range: 60 to 110 milligrams per deciliter.
      • NPO (nothing by mouth) after midnight, drawn in the morning.
    • Capillary Glucose (Acute Che, blood capillary glucose)
      • Finger stick test.
    • Glucose Tests:
      • AC (before meals).
      • HS (at bedtime).
      • Postprandial (2 hours after a meal).
    • Glucose Tolerance Test
      • Ordered for pregnant individuals with elevated glucose levels.
      • NPO after midnight.
      • Blood and urine samples collected at 1 and 3 hours after drinking 75 grams of sugar.
      • Avoid tobacco, drugs, and other substances that could affect the test.
    • Elevated glucose levels: Indicate a problem with carbohydrate metabolism.

    Hemoglobin A1c

    • Also known as Glycosylated Hemoglobin.
    • Reflects average blood sugar levels over the past 120 days (3 months).
    • No special preparation needed.
    • Elevated levels: May indicate diabetes.
    • Normal range: 4 to 7% (most doctors prefer less than 7%).
    • 10-20%: Indicates very poor diabetic control.
    • Children: Normal range 1.8 to 4%.

    Hypoglycemia

    • Blood sugar below 60 milligrams per deciliter.
    • More dangerous than hyperglycemia as the brain needs sugar to function.
    • Recheck blood sugar for accuracy.
    • If the patient is awake and alert:
      • Provide orange juice, other fruit juice, hard candy, or honey.
      • Commercial glucose can also be used.
    • If the patient is not awake and alert:
      • Administer glucagon subcutaneously (SQ), intramuscularly (IM), or intravenously (IV).
      • Give glucose (10% or 50%) intravenously (IV) by a Registered Nurse (RN).

    Uric Acid

    • Elevated levels: Seen in individuals with gout.
    • No special preparation needed.
    • Normal range: 3 to 7 milligrams per deciliter.

    Creatinine

    • Assesses kidney function.
    • Elevated levels: May indicate kidney failure.
    • Normal range: 0.6 to 1.2 milligrams per deciliter.

    Blood Urea Nitrogen (BUN)

    • Assesses Kidney function.
    • Elevated levels: Seen in dehydration and kidney impairment.
    • Normal range: 10 to 20 milligrams per deciliter.
    • If creatinine is normal and BUN is high: Typically indicates dehydration.
    • If both BUN and creatinine are elevated: Typically indicates a kidney function issue.

    Electrolytes

    • Assess electrolyte balance in the body.
    • Potassium
      • Normal range: 3.5 to 5 milliequivalents per liter.
    • Sodium
      • Normal range: 135 to 145 milliequivalents per liter.

    Triglycerides

    • Measures fats in the blood.
    • Preparation:
      • Patient must be NPO (nothing by mouth) for 12 to 14 hours prior to the test.
      • No alcohol for 24 hours prior to the test.
      • High-fat diet up to 2 weeks prior to the test may elevate findings.
    • Normal range:
      • Males: 40 to 160 milligrams per deciliter.
      • Females: 35 to 135 milligrams per deciliter.
    • Critical Value: Greater than 400 milligrams per deciliter.
      • Immediately notify the provider if a critical value is identified.

    Lipoproteins

    • High-Density Lipoprotein (HDL): "Good" cholesterol
      • Normal range: 30 to 80 milligrams per deciliter.
      • Lower level: Greater risk of heart disease.
      • Higher level: Lower risk of heart disease.
    • Low-Density Lipoprotein (LDL): "Bad" cholesterol
      • Normal range: 60 to 180 milligrams per deciliter.
      • Aim for the lowest possible levels.
    • Very Low-Density Lipoprotein (VLDL): "Very bad" cholesterol
      • Normal range: 25 to 50 milligrams per deciliter.
      • Aim for the lowest possible levels.
    • Preparation:
      • Patient must be NPO (nothing by mouth) for 12 to 14 hours prior to the test.
      • Abstain from smoking and alcohol before the test.

    Cholesterol

    • Preparation:
      • 12 to 14 hours NPO after a low-fat diet.
      • No alcohol for 24 hours prior to the test.
    • Goal: Cholesterol less than 200 milligrams per deciliter.

    Urinalysis

    • Analysis of urine to detect abnormalities.
    • Obtaining a specimen:
      • Patient urinates into a cup.
      • Avoid contamination of the inside of the cup.
      • Label the container properly (on the side, not the top).
    • Tests:
      • pH
      • Specific gravity
      • Protein
      • Glucose
      • Ketones
      • Blood
      • White blood cell count
    • If infection is suspected, a culture and sensitivity may be ordered:
      • Culture: Identifies the organism causing the infection.
      • Sensitivity: Determines which antibiotics the organism is susceptible to.
    • Urinalysis Types:
      • Midstream: Collected during urination after initial flow starts and before it ends.
      • Voided: First voided specimen (urination after waking up).
      • Sterile or Catheterized: A sterile catheter is inserted to collect the urine.
        • Never remove a catheter from a drainage bag unless it was just inserted.
        • Use a syringe with a needle to collect urine from the port on the catheter.
      • Residual urine:
        • Patient urinates normally, then a catheter is inserted 10 minutes later to empty the bladder.
        • Measure the amount of urine collected.
        • Less than 50 mL: No residual urine.
        • Greater than 50 mL: Indicates residual urine, increasing infection risk.
    • Normal Urine Values:
      • Pale yellow or amber.
      • Clear or slightly hazy.
      • pH 4.6 to 8.
      • Specific gravity 1.003 to 1.030.
      • Glucose: Negative.
      • Bilirubin: Negative.
      • Ketones: Negative.
      • Protein: Negative.
      • Red blood cells: 0 to 2 per high-power field.
      • White blood cells: 0 to 4 per high-power field.
      • Bacteria: Negative.

    24-Hour Urine Urinalysis

    • Collect urine for 24 hours.
    • Steps:
      • Start timer when the patient first urinates.
      • Discard the first urine sample.
      • Collect all urine samples over 24 hours in a container on ice.
      • Collect the final urine sample 10 minutes before the 24-hour mark.
      • If any samples are missed or contaminated, the entire process must be restarted.

    Blood Cultures

    • Typically drawn from two sites (left & right arm, or as ordered).
    • If antibiotics are ordered with blood cultures: Always do the culture first.
    • For accurate results, proper technique and specimen handling are crucial.

    Sputum

    • Collect a specimen from the lungs.
    • Best time: Early in the morning (a.m.) before the respiratory tract is cleared.
    • Preparation:
      • Encourage fluids to liquefy secretions.
      • Avoid contaminating the specimen container.
      • Respiratory treatment may be needed to help the patient cough up thick mucus.
      • Explain to the patient: Secretion should be from the lungs, not the mouth.
      • Collect from deep in the bronchial tree.
      • Suctioning can be used if needed.

    Stool Specimen

    • Not sterile.
    • Collect warm, fresh specimen.
    • Ova and Parasite Testing: Obtain samples from different areas of the stool.
    • If the patient is a baby in a diaper, the entire diaper can be sent to the lab.
    • Patient Education:
      • Explain how foods and medications affect the test results.
      • Avoid: Red meat, cantaloupe, uncooked broccoli, turnips, Vitamin C, aspirin, insulin.
      • Document if the patient is on any anticoagulants.

    Specimen Collection

    • Avoid urine contamination when collecting stool specimens.
    • Digital Exams: May be needed for specimen collection, depending on the patient.
    • Wound Cultures:
      • Collect after cleaning the wound to ensure accurate results.
      • Use a sterile swab.
      • Administer pain medication 30 minutes prior to a painful procedure.
      • Collect from inside the wound.
      • Collect in conjunction with a dressing change to avoid multiple procedures.

    Capillary Blood Glucose (CBG)

    • A lancet is used to collect a blood sample.
    • Technique:
      • Clean the finger with an alcohol pad.
      • Prick the side of the finger (not the middle).
      • Apply pressure to the puncture site until bleeding stops.
    • Infants: Blood sample is collected via a heel stick.
    • Discard the strip and lancet in the appropriate sharps container.

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    Test your knowledge on Complete Blood Count (CBC) and coagulation tests including PTT, PT, and INR. This quiz covers normal values, therapeutic ranges, and considerations for managing patients on anticoagulant therapy. Perfect for nursing and medical students.

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